BackgroundIn Japan, the first human milk bank (HMB) was established in 2017, which changed the practice of enteral feeding in neonatal care. This study investigated the practice of enteral feeding of preterm infants after the establishment of the HMB in Japan and examined related future issues.MethodsA survey on enteral feeding and the use of the HMB was conducted in 251 neonatal intensive care units (NICUs) from December 2020 to February 2021.ResultsThe response rate was 61%. The ideal times to start enteral feeding for extremely‐low‐birthweight infants (ELBWI) and very‐low‐birthweight infants (VLBWI) were within 24 h after birth in approximately 59% and 62% of NICUs, however, only 30% and 46% could do so, respectively. Artificial nutrition was used to initiate enteral feeding for ELBWIs and VLBWIs in in 24% and 56% of NICUs, respectively. Of the NICUs, 92% considered the HMB “necessary” or “rather necessary”. Fifty‐five percent wanted to use the HMB but could not. The major reasons for this were (1) difficulty in paying the annual membership fee, (2) difficulty obtaining approval from the NICU, and (3) complexity in using the facility. The indications for using and discontinuation of use of donor milk varied among the NICUs. Only in 17%, milk expression was within 1h after delivery.ConclusionsCompared with before the establishment of the HMB, NICUs are currently more willing to start enteral feeding for preterm infants earlier. However, the implementation of enteral feeding appears to be challenging. Issues related to the HMB highlighted by the responses need to be addressed. Additionally, guidelines for using donor milk should be established.
Background Chronic lung disease (CLD) is a major neonatal pulmonary disorder associated with inflammation. Recent studies have shown that protein C anticoagulant pathways, such as those for protein C (PC), protein S (PS), and thrombomodulin (TM), could be useful indices for reflecting pulmonary injury. However, the involvement of these factors in preterm infants with very low birthweight (VLBW) who have developed CLD remains to be investigated. Here, we investigated whether PC pathway‐related factors could predict the development of CLD in preterm infants with VLBW. Methods We collected plasma samples from 26 preterm infants with VLBW (13 each from those with and without CLD) at the time of birth and measured TM, PC, and PS levels in their plasmas. We analyzed prospectively the relationship between these factors in infants with and without CLD. Results There were significant differences in gestational age, birthweight, Apgar score (5 min), and duration of mechanical ventilation between the CLD and non‐CLD groups. No significant differences in the PC and PS levels at birth were observed between the two groups, whereas the TM levels in the CLD group were significantly higher than those in the non‐CLD group (P = 0.013). The TM levels correlated with gestational age and duration of mechanical ventilation. However, covariance analysis demonstrated that gestational age was significantly associated with TM levels, and consequently, development of CLD was not associated with TM level at birth. Conclusions Thrombomodulin, PC, and PS levels at birth could not predict the development of CLD in preterm infants with VLBW.
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